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. 2025 May 20;25(1):723.
doi: 10.1186/s12879-025-11134-8.

The association of sepsis bundle compliance with mortality in patients with ICU-acquired sepsis: a cohort study

Adam Green  1 , Sharad Patel  2 , Pamela Crabtree  3 , Divyesha Patel  4 , Andrew Hoke  4 , Ricardo Jaime Orozco  5 , George Sangah  6 , Alvin Mercado  7 , Nicole Melchiorre  7 , Mariane Charron  2 , Abhimanyu Chandel  8 , Nitin Puri  2
Affiliations

The association of sepsis bundle compliance with mortality in patients with ICU-acquired sepsis: a cohort study

Adam Green et al. BMC Infect Dis. .

Abstract

Background: The efficacy of the SEP-1 Bundle has been questioned in the treatment of patients with hospital-acquired sepsis. We aimed to investigate bundle compliance and its association with survival in a subset of patients with HA sepsis: those with ICU-acquired sepsis.

Methods: A single-center retrospective cohort study was conducted in a tertiary care referral hospital. Adult patients diagnosed with ICU-acquired sepsis between 1 January 2019 and 31 December 2022 were identified. Survival to hospital discharge adjusted for disease severity based on 3-hour, 6-hour, and total bundle compliance was calculated. Secondary outcomes included the need for mechanical ventilation, vasopressors, initiation of acute hemodialysis, and discharge location.

Results: Of 191 patients with ICU-acquired sepsis, 61 patients (31.9%) demonstrated total bundle compliance. There was no difference in survival based on the unadjusted analysis of 3-hour bundle compliance, compliant versus non-compliant (78.9% vs. 67.0%; P = 0.100). However, there was a survival benefit in 6-hour and total bundle, compliance versus non-compliance (82.2% vs. 60.0%, P < 0.001; 86.9% vs. 64.6%, P = 0.002). When adjusted for SOFA and CCI, logistic regression demonstrated similar results: 3-hour compliance (OR: 0.60; 95% CI: 0.29-1.18, P = 0.150), 6-hour compliance (OR: 0.35; 95% CI: 0.17-0.68, P = 0.002) and total compliance (OR: 0.31; 95% CI: 0.13-0.69, P = 0.006). Components of the SEP-1 Bundle that showed a mortality benefit included the collection of "blood cultures prior to antibiotic administration" (OR: 0.46; 95% CI 0.22-0.96, P = 0.037) and "tissue perfusion assessment" (OR: 0.41; 95% CI 0.18-0.90, P = 0.028).

Conclusions: Six-hour and total SEP-1 bundle compliance was associated with increased hospital survival in patients with ICU-acquired sepsis. These findings suggest the importance of sepsis bundle compliance in the ICU environment.

Clinical trial number: Not Applicable.

Keywords: ICU-acquired sepsis; Nosocomial sepsis; SEP-1 bundle; Sepsis; Sepsis bundle compliance.

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Conflict of interest statement

Declarations. Ethical approval: The study received ethical approval and was conducted in accordance with ethical standards. This study adhered to the Declaration of Helsinki. Cooper University Healthcare, IRB approval 22–292. Consent to participate: Given the study’s retrospective nature, consent to participate was waived per CUH IRB guidelines. Obtaining consent would have precluded the ability to complete the project. No unnecessary protected health information was collected and standard procedures to protect the information were taken. Consent for publication: NA. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Survival analysis based on compliance
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